Provider Demographics
NPI:1558341487
Name:JUSTINIANO, ROSE EILEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:EILEEN
Last Name:JUSTINIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CALLE BIMINI
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5120
Mailing Address - Country:US
Mailing Address - Phone:787-823-0110
Mailing Address - Fax:
Practice Address - Street 1:67 CALLE 65 INFANTERIA
Practice Address - Street 2:SUITE A-109
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2909
Practice Address - Country:US
Practice Address - Phone:787-826-2145
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15,674208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice